community care plan (ccp) and ccp florida healthy kids d.0 … · 2020. 8. 18. · community care...

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Community Care Plan (CCP) and CCP Florida Healthy Kids NCPDP D.0 Payer Specifications

July 24, 2020

Request Claim Billing/Claim Re-bill Payer Sheet

**Start of Request Claim Billing/Claim Re-bill (B1/B3) Payer Sheet**

General Information

Payer Name: Magellan Rx Management

Plan Name/Group Name: CCP/SFCCNRX1 BIN: 016523 PCN: 732

Plan Name/Group Name: CCP Florida Healthy Kids/CCPFHK1 BIN: 016523 PCN: 22796

Processor: Magellan Rx Management

Effective as of: 07/01/2014 NCPDP Telecommunication Standard Version/Release #: D.0

Pharmacy Support: 1-800-424-7897

NCPDP Data Dictionary Version Date: October 2011 NCPDP External Code List Version Date: October 2011

Other versions supported: No lower versions supported.

Other Transactions Supported

Transaction Code Transaction Name

B2 Reversal

B3 Re-bill

E1 Eligibility Verification

| Community Care Plan (CCP) and CCP Florida Healthy Kids NCPDP D.0 Payer Specifications

Field Legend for Columns

Payer Usage Column Value Explanation Payer Situation

Column

MANDATORY M The Field is mandatory for the Segment in the designated

Transaction.

No

REQUIRED R The Field has been designated with the situation of

“Required” for the Segment in the designated Transaction.

No

QUALIFIED

REQUIREMENT

RW “Required when.” The situations designated have

qualifications for usage (“Required if x,” “Not required if y”).

Yes

Fields that are not used in the Claim Billing/Claim Re-bill transactions and those that do not

have qualified requirements (i.e., not used) for this payer are excluded from the template.

Claim Billing/Claim Re-bill Transaction

The following lists the segments and fields in a Claim Billing or Claim Re-bill Transaction for the

NCPDP Telecommunication Standard Implementation Guide Version D.Ø.

Transaction Header Segment Questions Check Claim Billing/Claim Re-bill

If Situational, Payer Situation

This Segment is always sent X

Source of certification IDs required in

Software Vendor/Certification ID (11Ø-

AK) is not used

X

Transaction Header Segment Claim Billing/Claim Re-bill

Field # NCPDP Field Name Value Payer Usage Payer Situation

1Ø1-A1 BIN NUMBER 016523 M

1Ø2-A2 VERSION/RELEASE

NUMBER

DØ M

1Ø3-A3 TRANSACTION CODE B1, B3 M

1Ø4-A4 PROCESSOR CONTROL

NUMBER

732 M

1Ø9-A9 Transaction Count • 1–4

• Max of ‘1’ allowed

for compound

transactions.

M

2Ø2-B2 SERVICE PROVIDER ID

QUALIFIER

‘01’ = National

Provider ID

M

2Ø1-B1 SERVICE PROVIDER ID NPI M

4Ø1-D1 DATE OF SERVICE M


|

Transaction Header Segment Claim Billing/Claim Re-bill


11Ø-AK SOFTWARE

VENDOR/CERTIFICATION

ID

M Assigned when vendor is

certified with Magellan Rx

Management

Insurance Segment Questions Check Claim Billing/Claim Re-bill



Insurance Segment Segment Identification (111-AM) = “Ø4”

Claim Billing/Claim Re-bill


3Ø2-C2 CARDHOLDER ID M

312-CC CARDHOLDER FIRST NAME R

313-CD CARDHOLDER LAST NAME R

3Ø1-C1 GROUP ID SFCCNRX1 R SFCCNRX1

3Ø3-C3 PERSON CODE R

3Ø6-C6 PATIENT RELATIONSHIP

CODE

R

Patient Segment Questions Check Claim Billing/Claim Re-bill



Patient Segment Segment Identification (111-AM) = “Ø1”


Field NCPDP Field Name Value Payer Usage Payer Situation

331-CX PATIENT ID QUALIFIER RW Required if Patient ID (332-

CY) is used.

332-CY PATIENT ID RW Required if necessary for

state/federal/regulatory

agency programs to validate

dual eligibility.

3Ø4-C4 DATE OF BIRTH Patient’s Date of Birth R

3Ø5-C5 PATIENT GENDER CODE R

31Ø-CA PATIENT FIRST NAME R

311-CB PATIENT LAST NAME R

3Ø7-C7 PLACE OF SERVICE RW Required if this field could

result in different coverage,

pricing, or patient financial

responsibility.


Patient Segment Segment Identification (111-AM) = “Ø1”


Field NCPDP Field Name Value Payer Usage Payer Situation

335-2C PREGNANCY INDICATOR RW Required if pregnancy could



responsibility.

384-4X PATIENT RESIDENCE RW • Required if this field could

result in different

coverage, pricing, or

patient financial

responsibility.

• Required when known.

Claim Segment Questions Check Claim Billing/Claim Re-bill



This payer supports partial fills X

Claim Segment Segment Identification (111-AM) = “Ø7”



455-EM PRESCRIPTION/SERVICE

REFERENCE NUMBER

QUALIFIER

1 = Rx Billing M For Transaction Code of “B1,”

in the Claim Segment, the

Prescription/Service

Reference Number Qualifier

(455-EM) is “1” (Rx Billing).

4Ø2-D2 PRESCRIPTION/SERVICE

REFERENCE NUMBER

M

436-E1 PRODUCT/SERVICE ID

QUALIFIER

• ‘03’ = National

Drug Code (NDC)

• ‘00’ = Not Specified

(Use for

Compounds)

M

4Ø7-D7 PRODUCT/SERVICE ID • National Drug

Code (NDC)

• ‘Ø’ for Compound

M

456-EN ASSOCIATED

PRESCRIPTION/SERVICE

REFERENCE NUMBER

RW • Required if the

“completion” transaction

in a partial fill

(Dispensing Status [343-

HD] = “C” [Completed]).

• Required if the

Dispensing Status (343-


|




HD) = “P” (Partial Fill)

and there are multiple

occurrences of partial fills

for this prescription.

457-EP ASSOCIATED

PRESCRIPTION/SERVICE

DATE

RW • Required if the

“completion” transaction

in a partial fill

(Dispensing Status [343-

HD] = “C” [Completed]).

• Required if Associated


Reference Number (456-

EN) is used.

• Required if the

Dispensing Status (343-

HD) = “P” (Partial Fill)

and there are multiple

occurrences of partial fills

for this prescription.

442-E7 QUANTITY DISPENSED R

460-ET QUANTITY PRESCRIBED RW Imp Guide: Required when a

transmission is for a

Scheduled II drug as defined

in 21 CFR 1308.12 and per

CMS-0055-F (Compliance

Date 09/21/2020. Refer to the

Version D.0 Editorial

Document).

4Ø3-D3 FILL NUMBER R

4Ø5-D5 DAYS SUPPLY R

4Ø6-D6 COMPOUND CODE R

4Ø8-D8 DISPENSE AS WRITTEN

(DAW)/PRODUCT

SELECTION CODE

R

414-DE DATE PRESCRIPTION

WRITTEN

R

415-DF NUMBER OF REFILLS

AUTHORIZED

R





419-DJ PRESCRIPTION ORIGIN

CODE

• 1 = Written

• 2 = Telephone

• 3 = Electronic

• 4 = Facsimile

• 5 = Pharmacy

R

354-NX SUBMISSION

CLARIFICATION CODE

COUNT

Maximum count of 3 RW Required if Submission

Clarification Code (42Ø-DK)

is used.

42Ø-DK SUBMISSION

CLARIFICATION CODE

RW Required if clarification is

needed and value submitted is

greater than zero (Ø).

3Ø8-C8 OTHER COVERAGE CODE • ‘00’ = Not specified

• ‘01’ = No other

coverage

• ‘02’ = Other

coverage exists –

payment collected

• ‘03’ = Other

coverage exists –

claim not covered

• ‘04’ = Other

coverage exists –

payment not

collected

RW • Imp Guide: Required if

needed by receiver, to

communicate a

summation of other

coverage information that

has been collected from

other payers.

• Required for Coordination

of Benefits.

6ØØ-28 UNIT OF MEASURE • EA = Each

• GM = Grams

• ML = Milliliters

R

418-DI LEVEL OF SERVICE RW Required if this field could



responsibility.

461-EU PRIOR AUTHORIZATION

TYPE CODE

RW Required if this field could



responsibility.

462-EV PRIOR AUTHORIZATION

NUMBER SUBMITTED

RW Required if this field could



responsibility.


|




343-HD DISPENSING STATUS RW Required for the partial fill or

the completion fill of a

prescription.

344-HF QUANTITY INTENDED TO

BE DISPENSED

RW Required for the partial fill or


prescription.

345-HG DAYS SUPPLY INTENDED

TO BE DISPENSED

RW Required for the partial fill or


prescription.

995-E2 ROUTE OF

ADMINISTRATION

SNOMED RW • Required if specified in

trading partner

agreement.

• Payer Requirement:

Required when

submitting Compounds

996-G1 COMPOUND TYPE RW • Required if specified in

trading partner

agreement.


Required when known.

147-U7 PHARMACY SERVICE TYPE RW • Required when the

submitter must clarify the

type of services being

performed as a condition

for proper reimbursement

by the payer.


Required when known.

Pricing Segment Questions Check Claim Billing/Claim Re-bill



Pricing Segment Segment Identification (111-AM) = “11”



4Ø9-D9 INGREDIENT COST

SUBMITTED

R

412-DC DISPENSING FEE

SUBMITTED

RW Required if its value has an

effect on the Gross Amount

Due (43Ø-DU) calculation.


Pricing Segment Segment Identification (111-AM) = “11”



438-E3 INCENTIVE AMOUNT

SUBMITTED




481-HA FLAT SALES TAX AMOUNT

SUBMITTED




482-GE PERCENTAGE SALES TAX

AMOUNT SUBMITTED




483-HE PERCENTAGE SALES TAX

RATE SUBMITTED

RW • Required if Percentage

Sales Tax Amount

Submitted (482-GE) and

Percentage Sales Tax

Basis Submitted (484-JE)

are used.

• Required if this field could

result in different pricing.

• Required if needed to

calculate Percentage Sales

Tax Amount Paid (559-

AX).

484-JE PERCENTAGE SALES TAX

BASIS SUBMITTED

RW • Required if Percentage

Sales Tax Amount

Submitted (482-GE) and

Percentage Sales Tax

Rate Submitted (483-HE)

are used.

• Required if this field could

result in different pricing.

• Required if needed to

calculate Percentage Sales

Tax Amount Paid (559-

AX).

426-DQ USUAL AND CUSTOMARY

CHARGE

R Required if needed per

trading partner agreement.

43Ø-DU GROSS AMOUNT DUE R

423-DN BASIS OF COST

DETERMINATION

RW Required if needed for

receiver claim/encounter

adjudication.


|

Prescriber Segment Questions Check Claim Billing/Claim Re-bill



Prescriber Segment Segment Identification (111-AM) = “Ø3”



466-EZ PRESCRIBER ID QUALIFIER Ø1 = NPI R

411-DB PRESCRIBER ID NPI R

427-DR PRESCRIBER LAST NAME RW Required when the Prescriber

ID (411-DB) is not known.

Coordination of Benefits/Other Payments Segment Questions

Check Claim Billing/Claim Re-bill


This Segment is situational X Required only for secondary, tertiary, etc.,

claims

Scenario 1 – Other Payer Amount Paid

Repetitions Only

Coordination of Benefits/Other Payments Segment

Segment Identification (111-AM) = “Ø5”

Claim Billing/Claim Re-bill Scenario 1 – Other Payer Amount Paid Repetitions Only


337-4C COORDINATION OF

BENEFITS/OTHER

PAYMENTS COUNT

Maximum count of 9 M

338-5C OTHER PAYER COVERAGE

TYPE

M

339-6C OTHER PAYER ID

QUALIFIER

03 = BIN

99 – Other

RW Required if Other Payer ID

(34Ø-7C) is used.

34Ø-7C OTHER PAYER ID RW Required if identification of the

Other Payer is necessary for

claim/encounter adjudication.

443-E8 OTHER PAYER DATE RW Required if identification of the

Other Payer Date is necessary

for claim/encounter

adjudication.

341-HB OTHER PAYER AMOUNT

PAID COUNT

Maximum count of 9 R Required if Other Payer

Amount Paid Qualifier (342-

HC) is used.

342-HC OTHER PAYER AMOUNT

PAID QUALIFIER

Ø7 = Drug Benefit R Required if Other Payer

Amount Paid (431-DV) is used.


Coordination of Benefits/Other Payments Segment

Segment Identification (111-AM) = “Ø5”

Claim Billing/Claim Re-bill Scenario 1 – Other Payer Amount Paid Repetitions Only


431-DV OTHER PAYER AMOUNT

PAID

R Required if other payer has

approved payment for some/all

of the billing.

471-5E OTHER PAYER REJECT

COUNT

Maximum count of 5 RW Required if Other Payer Reject

Code (472-6E) is used.

472-6E OTHER PAYER REJECT

CODE

RW Required when the other payer

has denied the payment for the

billing.

DUR/PPS Segment Questions Check Claim Billing/Claim Re-bill


This Segment is situational X

DUR/PPS Segment Segment Identification (111-AM) = “Ø8”


Field # NCPDP Field Name Value Payer Usage

Payer Situation

473-7E DUR/PPS CODE COUNTER Maximum of 9

occurrences.

(‘1’ – Maximum of one

allowed)

R*** Required if DUR/PPS Segment is

used.

439-E4 REASON FOR SERVICE

CODE

RW*** • Required if this field could


pricing, patient financial

responsibility, and/or drug

utilization review outcome.

• Required if this field affects

payment for or

documentation of

professional pharmacy

service.

44Ø-E5 PROFESSIONAL SERVICE

CODE

RW*** • Required if this field could






payment for or

documentation of


|

DUR/PPS Segment Segment Identification (111-AM) = “Ø8”



Payer Situation


service.

441-E6 RESULT OF SERVICE CODE RW*** • Required if this field could






payment for or

documentation of


service.

474-8E DUR/PPS LEVEL OF

EFFORT

RW • Required if this field could






payment for or

documentation of


service.


Required for Compounds

Compound Segment Questions Check Claim Billing/Claim Re-bill



Compound Segment Segment Identification (111-AM) = “1Ø”



45Ø-EF COMPOUND DOSAGE FORM

DESCRIPTION CODE

M

451-EG COMPOUND DISPENSING

UNIT FORM INDICATOR

M

447-EC COMPOUND INGREDIENT

COMPONENT COUNT

M Maximum 25 ingredients

488-RE COMPOUND PRODUCT ID

QUALIFIER

M***


Compound Segment Segment Identification (111-AM) = “1Ø”



489-TE COMPOUND PRODUCT ID M***

448-ED COMPOUND INGREDIENT

QUANTITY

M***

449-EE COMPOUND INGREDIENT

DRUG COST

M***

49Ø-UE COMPOUND INGREDIENT

BASIS OF COST

DETERMINATION

R***

Clinical Segment Questions Check Claim Billing/Claim Re-bill



Clinical Segment Segment Identification (111-AM) = “13”



Payer Situation

491-VE DIAGNOSIS CODE COUNT Maximum count of 5.

(‘1’ – Maximum of one

allowed)

RW Required if Diagnosis Code

Qualifier (492-WE) and

Diagnosis Code (424-DO) are

used.

492-WE DIAGNOSIS CODE

QUALIFIER

RW*** Required if Diagnosis Code (424-

DO) is used.

424-DO DIAGNOSIS CODE RW*** • Required if this field could






payment for professional

pharmacy service.

• Required if this information

can be used in place of prior

authorization.

• Required if necessary for

state/federal/regulatory

agency programs.

493-XE CLINICAL INFORMATION

COUNTER

RW*** Grouped with Measurement

fields (Measurement Date (494-

ZE), Measurement Time (495-


|




Payer Situation

H1), Measurement Dimension

(496-H2), Measurement Unit

(497-H3), Measurement Value

(499-H4).

494-ZE MEASUREMENT DATE RW*** Required if necessary when this

field could result in different

coverage and/or drug utilization

review outcome.

495-H1 MEASUREMENT TIME RW*** • Required if Time is known or

has impact on measurement.

• Required if necessary when

this field could result in

different coverage and/or

drug utilization review

outcome.

496-H2 MEASUREMENT

DIMENSION

RW*** • Required if Measurement

Unit (497-H3) and

Measurement Value (499-

H4) are used.





outcome.


patient’s weight and height

when billing Medicare for a

claim that includes a

Certificate of Medical

Necessity (CMN).

497-H3 MEASUREMENT UNIT RW*** • Required if Measurement

Dimension (496-H2) and

Measurement Value (499-

H4) are used.






Necessity (CMN).





Payer Situation





outcome.

499-H4 MEASUREMENT VALUE RW*** • Required if Measurement

Dimension (496-H2) and

Measurement Unit (497-H3)

are used.






Necessity (CMN).





outcome.

**End of Request Claim Billing/Claim Re-bill (B1/B3) Payer Sheet**


|

Claim Reversal Accepted/Approved Response

**Start of Claim Reversal Response (B2) Payer Sheet**

General Information

Payer Name: Community Care Network

Plan Name/Group Name: Community Care Plan/ SFCCNRX1 BIN: 016523 PCN: 732

Plan Name/Group Name: CCP Florida Healthy Kids/ CCPFHK1 BIN: 016523 PCN: 22796

Claim Reversal Accepted/Approved Response

The following lists the segments and fields in a Claim Reversal response (Approved) Transaction for

the NCPDP.

Telecommunication Standard Implementation Guide Version D.Ø.

Response Transaction Header Segment Questions

Check Claim Reversal

Accepted/Approved If Situational, Payer Situation


Response Transaction Header Segment Claim Reversal

Accepted/Approved



NUMBER

DØ M

1Ø3-A3 TRANSACTION CODE B2 M

1Ø9-A9 TRANSACTION COUNT • 1–4

• Max of ‘1’

allowed for

compound

transactions.

M

5Ø1-F1 HEADER RESPONSE

STATUS

A = Accepted M


QUALIFIER

01 M 01 – National Provider

Identifier (NPI)

2Ø1-B1 SERVICE PROVIDER ID National Provider

Identifier (NPI)

M

4Ø1-D1 DATE OF SERVICE Same value as in

request

M





This Segment is always sent

This Segment is situational X Provide general information when used for

transmission-level messaging.

Response Transaction Header Segment Segment Identification (111-AM) = “2Ø”

Claim Reversal Accepted/Approved


5Ø4-F4 MESSAGE RW • Imp Guide: Required if

text is needed for

clarification or detail.

• Payer Requirement: Same

as Imp Guide.

Response Status Segment Questions Check Claim Reversal



Response Status Segment Segment Identification (111-AM) = “21”



112-AN TRANSACTION

RESPONSE STATUS

A = Approved M

5Ø3-F3 AUTHORIZATION

NUMBER


needed to identify the

transaction.


as Imp Guide.

547-5F APPROVED MESSAGE

CODE COUNT

Maximum count of

5.

RW*** • Imp Guide: Required if

Approved Message Code

(548-6F) is used. Payer

Requirement: Same as Imp

Guide.

548-6F APPROVED MESSAGE

CODE


Approved Message Code

Count (547-5F) is used and

the sender needs to

communicate additional

follow up for a potential

opportunity.


as Imp Guide.


|




13Ø-UF ADDITIONAL MESSAGE

INFORMATION COUNT

Maximum count of

25.


Additional Message

Information (526-FQ) is

used.


as Imp Guide.

132-UH ADDITIONAL MESSAGE

INFORMATION

QUALIFIER


Additional Message


used.


as Imp Guide.

526-FQ ADDITIONAL MESSAGE

INFORMATION

RW*** • Imp Guide: Required when

additional text is needed

for clarification or detail.


as Imp Guide.

131-UG ADDITIONAL MESSAGE

INFORMATION

CONTINUITY

RW*** • Imp Guide: Required if and

only if current repetition of

Additional Message


used, another populated

repetition of Additional

Message Information (526-

FQ) follows it, and the text

of the following message is

a continuation of the

current.


as Imp Guide.

549-7F HELP DESK PHONE

NUMBER QUALIFIER


Help Desk Phone Number

(55Ø-8F) is used. Payer

Requirement: Same as Imp

Guide.

55Ø-8F HELP DESK PHONE

NUMBER


needed to provide a

support telephone number

to the receiver.


as Imp Guide.


Response Claim Segment Questions Check Claim Reversal



Response Claim Segment Segment Identification (111-AM) = “22”




REFERENCE NUMBER

QUALIFIER

1 M Imp Guide: For Transaction

Code of “B2,” in the Response

Claim Segment, the



(455-EM) is “1” (Rx Billing).


REFERENCE NUMBER

M

Response Pricing Segment Questions Check Claim Reversal




Response Transaction Header Segment Segment Identification (111-AM) = “23”



521-FL INCENTIVE AMOUNT

PAID


this field is reporting a

contractually agreed upon

payment.


as Imp Guide.

5Ø9-F9 TOTAL AMOUNT PAID RW • Imp Guide: Required if

any other payment fields

sent by the sender.


as Imp Guide.


|

Claim Reversal Accepted/Rejected Response

Response Transaction Header Questions Check Claim Reversal

Accepted/Rejected If Situational, Payer Situation


This Segment is situational


Accepted/Rejected



NUMBER

DØ M


1Ø9-A9 TRANSACTION COUNT Same value as in

request

M


STATUS

A = Accepted M


QUALIFIER


Identifier (NPI)


Identifier (NPI)

M


request

M

Response Message Segment Questions Check Claim Reversal




Response Message Segment Segment Identification (111-AM) = “2Ø”

Claim Reversal Accepted/Rejected



text is needed for



as Imp Guide.


Response Status Segment Questions Check Claim Reversal






112-AN TRANSACTION

RESPONSE STATUS

R = Reject M


NUMBER

R

51Ø-FA REJECT COUNT Maximum count of

5.

R

511-FB REJECT CODE R

546-4F REJECT FIELD

OCCURRENCE

INDICATOR

RW*** • Imp Guide: Required if a

repeating field is in error,

to identify repeating field

occurrence.


as Imp Guide.


INFORMATION COUNT

Maximum count of

25.


Additional Message


used.


as Imp Guide.


INFORMATION

QUALIFIER


Additional Message


used.


as Imp Guide.


INFORMATION

RW*** • Imp Guide: Required

when additional text is

needed for clarification or

detail.


as Imp Guide.


INFORMATION

CONTINUITY


and only if current


Message Information

(526-FQ) is used, another


|




populated repetition of

Additional Message

Information (526-FQ)

follows it, and the text of

the following message is a

continuation of the

current.


as Imp Guide.


NUMBER QUALIFIER




Requirement: Same as

Imp Guide.


NUMBER


needed to provide a

support telephone

number to the receiver.


as Imp Guide.

Response Claim Segment Questions Check Claim Reversal



Response Claim Segment Segment Identification (111-AM) = “22




REFERENCE NUMBER

QUALIFIER

1 M Imp Guide: For Transaction

Code of “B2,” in the Response

Claim Segment, the



(455–EM) is “1” (Rx Billing).


REFERENCE NUMBER

M


Claim Reversal Rejected/Rejected Response



Rejected/Rejected If Situational, Payer Situation



Rejected/Rejected



NUMBER

DØ M


1Ø9-A9 TRANSACTION COUNT Same value as in

request

M


STATUS

A = Accepted M


QUALIFIER


Identifier (NPI)


Identifier (NPI)

M


request

M

Response Segment Questions Check Claim Reversal




Response Message Segment Segment Identification (111-AM) = “2Ø”

Claim Reversal Rejected/Rejected



text is needed for



as Imp Guide.

Response Segment Questions Check Claim Reversal




|

Response Message Segment Segment Identification (111-AM) = “21”



112-AN TRANSACTION

RESPONSE STATUS

R = Reject M


NUMBER

R

51Ø-FA REJECT COUNT Maximum count of

5.

R

511-FB REJECT CODE R

546-4F REJECT FIELD

OCCURRENCE

INDICATOR

RW*** • Imp Guide: Required if a

repeating field is in error,

to identify repeating field

occurrence.


as Imp Guide.


INFORMATION COUNT

Maximum count of

25.


Additional Message


used.


as Imp Guide.


INFORMATION

QUALIFIER


Additional Message


used.


as Imp Guide.


INFORMATION

RW*** • Imp Guide: Required

when additional text is

needed for clarification or

detail.


as Imp Guide.


INFORMATION

CONTINUITY


and only if current


Message Information

(526-FQ) is used, another

populated repetition of

Additional Message

Information (526-FQ)

follows it, and the text of


Response Message Segment Segment Identification (111-AM) = “21”



the following message is a

continuation of the

current.


as Imp Guide.


NUMBER QUALIFIER




Requirement: Same as

Imp Guide.


NUMBER


needed to provide a

support telephone

number to the receiver.


as Imp Guide.

**End of Claim Reversal (B2) Response Pay**


|

Revision History

Date Name Comments

07/01/2014 Implementation team Initial creation

07/24/2020

Steven Giera Added quantity prescribed field (# 460-ET) required for

Schedule II drugs in Claim Segment Ø7

Documentation Management

team

Rebranded; reformatted; updated and standardized naming

conventions; and added Revision History table

community care plan (ccp) and ccp florida healthy kids d.0 … · 2020. 8. 18. · community care...

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